A case report: giant urethral calculus

Abstract

Urethral calculi are rare cases of lower urinary tract stones and represent 1-2% of all urinary stone diseases. They most commonly originate from the upper urinary tract or bladder or are associated with urethral abnormalities such as urethral stricture, urethral diverticulum, and foreign bodies. Occasionally, calculi grow to an enormous size and are labeled as a "giant urethral calculus". Urethral calculi most commonly occur in males. When a stone occludes the urethra, it can cause acute urinary retention, urethral injury, and obstructive renal failure. A 54-year-old male came to the emergency department at Saiful Anwar General Hospital Malang with a chief complaint of suprapubic pain, radiating to the right and left medial thigh and tip of the penis, accompanied by dribbling urine. Back pain radiated to the tip of the penis; there was a history of stone expulsion 4 years before, but he had not sought any medical attention. On physical examination, palpation identified a firm mass, 6 * 3cm, in the ventral penis. Urethrolithotomy (with penile shaft skin degloved to the penoscrotal junction, and ventral incision through two layers with Monosyn 5-0) was performed. A huge stone, 6 * 3.5cm, weighing 60 g was removed. A silicone catheter was maintained for 4 weeks. Postoperative recovery was uneventful. Giant urethral calculi are rare cases, occurring most commonly in males. A diagnosis of urethral calculus should be considered in patients with difficulty in urinating or urine retention who have an additional history of persistent lower back pain and calculus expulsion. Through accurate and proper management, it is important to prevent long-term complications caused by urethral stones.